Community Health Nursing-powerpoint – Flashcards
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What is a health care system?
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the methods of health care delivery and management, including financing and coordination of services.
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Exemplars of health care system
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Types of reimbursement Medicare/Medicaid NYS DOH OSHA CDC Local Health Dept. Emergency Preparedness
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Definition- EPIDEMIOLOGY
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PP: measurement of the distribution and determinants of health, illness and occurrences in human populations. CDC: The study of the distribution (frequency, pattern) and determinants (cause, risk factors) of health-related states and events (not just diseases) in specified populations (neighborhood, city, school, state, country, global).
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Who do community nurses care for?
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Cares for the population.... everyone that is in the community
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What is the role of the government in public health?
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- assesses health care problems -provides access to services -ensures that services are delivered and outcomes are achieved
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What does Global Health- Institute of Health look at?
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Health problems, issues and concerns with an international and national impact... What things need to be discussed, what teachings or interventions are needed.
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Definition- Endemic
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Presence of disease or infection in a defined geographical area or population (example the measles outbreak in schools last year)
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Definition- Epidemic
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Rates of disease at a higher level than normal frequency (example the flu)
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Definition- Pandemic:
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Worldwide epidemic of disease
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Definition- Morbidity:
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Illness
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Definition- Mortality:
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Death
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What is the leading cause of non-fatal disease burdens worldwide?
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Mental and Substance Abuse disorders
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What are the goals and responsibilities of the public health nurse?
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1. Assess the needs of the community 2. conduct surveillance for communicable diseases 3. prevent and control the spread of disease 4. organize mass distribution of medications and vaccines 5. maintain communication 6. document events and interventions 7. ensure the safety and health of the community
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Definition- American Nurses Association 1980 of COMMUNITY HEALTH NURSE
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a synthesis of nursing theory and public health practice applied to promoting and preserving the health of populations, health promotion, health maintenance, health education and management, coordination and continuation of care are utilized in a holistic approach to the management of the health care of individual families and groups in the community.
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How long has public health nursing been in place?
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over 100 years
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Are we moving more towards community health or more towards institutional health
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towards community health
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What is is the order in which things are reported/communicated?
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1. Community health nurse reports to... 2. Clinics, Doctors and hospitals...who report to.... 3. The local health dept....who reports to.... 4. The State health department.... who reports to.... 5. The CDC.... This goes in reverse too... from 5 to 1
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what is the #1 place for medical care?
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The doctors office
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Are people referred to as Clients or Patients when in the community?
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Clients
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What types of things does the community health nurse need to be good at?
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As a nurse- more autonomy and accountability... they should have experience as a nurse As a case manager- they need to be able to collaborate with health care personnel like social services, PT/OT etc They should know other community agencies that can help the client... FLACRA, meals on wheels etc They also need to be really good at critical thinking... there is no Dr at the nurses station
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What is HOLISTIC care?
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treating them not only their physical needs but their psychological needs as well.
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When you think of Nursing in general, you normally think of Florence Nightingale. But when you think of Community Health Nursing you should think of who?
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Lillian Wald- who opened the Henry St. Settlement that is still opened today for families dealing with HIV
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What are three major dimensions of community health nursing practice?
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Wellness care Ambulatory Care Home Care
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What is Wellness Care?
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it involves health promotion and disease prevention
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What is Ambulatory Care?
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It involves treatments as well as wellness care
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What is Home Care?
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Care of home bound clients (By home bound, the patient can only go from home to doctors appointments. Anything other than that like going to the grocery store or the hair dresser, will disqualify them from home care and insurance will be cut)
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What does RNC stand for and what does it mean?
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Registered Nurse- Certificate: This simply means that the registered nurse has had additional education and has advanced knowledge in their specialty. This can be for a wide variety of specialties
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Interventions at community level includes three categories. What are they?
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Education Enforcement (smoking, speed, seat belts [more from law enforcement] Engineering (engineering productive ways to promote wellness [no smoking in or around any public buildings])
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Definition: Ethics
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a system of morals, principles, rules and guidelines
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Definition: Code of Ethics
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nurses accept a legal and moral obligation to abide by this when taking on nursing care in clinical care settings
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Definition: Ethical Principles
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Autonomy-- self determination and independence. Adults have the right to make their own decisions for health care.
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Definition: Beneficence
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Health care principles that mandate a nurse to do what is right for the client
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Definition: HIPAA
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Health Insurance Portability and Accountability Act: protects confidentiality of information related to medical records and services
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What is the root cause for a large number of sentinel events?
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Lack of communication
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Definition: Sentinel Events
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unexpected events or occurrences involving possible death; serious; or permanent physical/psychological harm
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What is one way used to improve communication?
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SBAR: Situation, Background, Assessment and Recommendation
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EBP basis for all nursing care has 5 steps-- what are they?
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Step 1: P-I-C-O Step 2: Review of Literature Step 3: Organize and Presentation of findings Step 4: Re-evaluation Step 5: Revise and offer choices that reflect best practices
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What does P-I-C-O stand for?
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P: patient/problem I: Intervention C: Comparison/Control O: Outcomes/Effects
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Holistic care encompasses what types of care?
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Physical and Psychological
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Who awards the certification of home care nursing?
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The State Health Department
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What are the three levels of disease prevention ?
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Primary Secondary Tertiary
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What is Primary care?
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PREVENTS diseases or injuries from happening
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What are some examples of Primary care?
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Immunizations, fitness centers, seat belts, family planning, fluoride supplements, water and air quality, decreased sun exposure, use of ear plugs, safety glasses
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What is Secondary care?
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Early identification and Rx, identify pathology
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What are some examples of secondary care?
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development screening, hypertensive crisis, SBE, mammography/testicular exams, visual screenings, hearing screenings, assessing growth and developments, lead screenings, TB, Pap smears, IMD/PKU
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What is Tertiary care?
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efforts to promote rehabilitation and decreases long term effects of disease. Try to reach optimal level of health.
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What are some examples of tertiary care?
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Diet, exercise, stress management, support groups, PT, mental health clinics, meals on wheels, restore to higher level of functioning, client with colostomy referred to a support group spinal cord injury to rehab center mental health counseling (rape victims)
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What does primary care promote?
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-review the aspects of nutrition, rest and exercise -promotes taking responsibilities for risk behaviors (smoking and drugs) -Encourage risk assessment- self testicular exam, SBE's
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What does secondary care promote?
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Screening case findings with age appropriate exams
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What does tertiary care promote?
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Introduce activities to improve quality of life, or accept limitation of treatments.
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What does OSHA do?
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-investigates injuries in workplace, periodic visits -maintains policy and procedures monitors safety issues -requires that all workers engaged in direct client care have hepatitis B vaccine available for free.
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What are some things that a community health nurse has to deal with?
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elder and child abuse mentally ill, homeless, Effects of the environment Disasters
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What are some effects of the environment?
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Lack of sanitation Poor housing homeless migrant worker weather poor nutrition
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What are three types of Disasters?
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Natural Accidental Terroristic
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What is a natural disaster?
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Earthquakes, Hurricanes, Tornadoes etc.
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What is an accidental disaster?
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truck accident with toxic chemicals
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DEFINITION: What is a terroristic disaster?
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and action intended to cause death or serious injuries to civilians.... (9/11; boston marathon; manchester concert).
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Health Care costs are the ______________________ _________________ of the national health plan
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universal componant
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What does EMTALA stand for and what is it's definition or purpose?
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Emergency Medical Treatment and Labor Act: This law ensures that anyone who comes to an ED, regardless of insurance status or ability to pay, must receive medical care and be stabilized
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Why are health care costs up?
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-More elderly are living longer -Cost of expensive tests -Salaries of health care workers- -Malpractice -unhealthy lifestyles- obesity is increasing in the US and the major reason for that is a sedentary lifestyle
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Who does medicare help cover?
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THE ELDERLY -people who have kidney failure -people with approved disabilities -dependents of people who are disabled
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Who does medicaid help cover?
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-PEOPLE WITH LO INCOME OF ANY AGE - Beneficiaries of Aid to Families with Dependant Children (AFDC) -Elderly, blind and disabled people covered by supplemental security benefits
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Definition: Medicare
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federally sponsored person over age 65 or those declared disabled, some medical coverage for elderly Americans
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DEFINITION: Medicaid
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government sponsored state administration program for medically indigent or those on public assistance
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Definition: COBRA (July 1997)
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Safeguards health coverage for people who change or lose their jobs
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Definition: Kassenbaum
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Kennedy Health Reform Act - can't bar insurers from denying coverage to workers whom have pre-existing conditions
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What are two sets of laws that impact on community health?
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Nurse Practice Act Torts of Malpractice
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What is the Nurse Practice Act?
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The scope of nursing practice allowed in each state
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What is torts of malpractice?
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Deals with legal wrongs, failure to meed appropriate standards, improper discharge of professional duties
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What is the fastest growing ethnic group in the U.S.A?
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Hispanic Americans
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What is cultural diversity?
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avoid stereotypes, attentive listening, observe, respect their beliefs
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What are some things to consider related to other people's culture?
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-Their health care beliefs -Illness beliefs and promotion -Interpersonal relations -Spiritual beliefs
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9/10 Americans believe in _________________ and in the belief of ________________
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God Prayer
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What are some alternative measures to help the patient besides medication?
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-Therapeutic touch -healing touch -relaxation -humor (significantly improves quality of life) -Stress management (Patch Adams, Robin Williams)
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Family is a _______________
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system/client
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What are the different types of families?
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-Nuclear -Extended -Adult married couples -single parents -blended families--increased divorce rate -same sex -LGBT- lesbian, gay, bisexual, transgender
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When there's a pattern there's a ______________
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problem
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What is the CDC and what do they do?
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Centers for disease control.... it is the center for information on communicable disease located in Atlanta. They distribute information via morbidity and mortality weekly report
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When the ill/injured are in the hospital setting being cared for a nurse they are called a ____________________
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patient
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When the ill/injured are in their home environment being cared for by a community nurse they are called a ____________________
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client
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In the client's home the home health nurse is the _______________ and the _______________ ________________________
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Guest Role Model
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The nurse is the ___________________ for the client
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advocate
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In what ways does the nurse advocate for the client?
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-unsafe environment -exploited primary caregiver -check family dynamics -talk with client personally - check support systems -coping mechanisms -stressors
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What is the #1 way to decrease infection?
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Washing hands
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Documentation is all about.....what?
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Reimbursement
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What is the most widely abused and most dangerous chemical?
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Nicotine
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1 in 5 deaths are related to what?
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Nicotine consumption
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What are some common diagnosis' that you will find in the community?
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-Diabetes -Heart Disease -Chronic Illnesses .....We're sending them home sooner and sicker than ever....
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How do you dispose of things in the home that are biohazardous?
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Flush it down the toilet and then follow it with one part bleach to 10 parts water
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When using a sharps container (any container) how full should you let it become before emptying it?
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no more than 75%
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How long can Hepatitis B live on a surface?
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at least one week at room temperature
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How long can HIV live on a surface?
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HIV becomes inactive as soon as it dries
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Can you put sharps in a recycling container or the trash?
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NO
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Who/What dictates the time period a Home Health Aid can be in the client's home?
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Insurance
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What is the average attention span time that you should be aware of when teaching a client something?
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20 minutes
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Who is legally responsible for the home health aid?
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The registered nurse
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What is P.E.S. and what does it stand for?
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It is an acronym for the Nursing process used in writing a nursing diagnosis P: (client) Problem E: etiology (related to) S: Systems that validate or confirm the problem (AEB)
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Trust is ____________
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earned
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How can the home health nurse ensure that the client is taking their medications correctly? ...or what is the nurse's responsibility when assessing the clients medicaitons?
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-check for mistakes -creative ways -drawing up medicaitons -visual aids -pre-fill -color coded container -Magnified insulin syringe
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If it is not _____________ it is not _________________
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written done
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What is an OASIS form and when is it used
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An Oasis form is used in the home health care environment when a new client is admitted to the nurse's care. It covers everything from the initial assessment to the clients spiritual and cultural beliefs. This is a big communication record and takes about 3 to 4 hours to complete
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teaching is a ______ part process
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2
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What are clinical path/critical pathways?
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Tells you what they should accomplish by what day....and how long insurance will pay -key events of a partial health problem that must occur for the client to reach set outcomes -help standardize care plans -sequence or time frame for interim for a specific disease -Achievement of client outcomes -many variables -# of visits or weeks for Dx
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Computers allow the home health RN to do what?
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allows for point of care documentation
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What are some barriers of care that the home health nurse will come across?
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Demographic Financial System Barriers Client Barriers
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What are Demographic errors that the home health nurse might come across?
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age education geographical location marital status minority employment status
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What are financial errors that the home health nurse might come across?
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poverty inadequate health insurance medicaid illegitimate determination
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What are system barriers that the home health nurse might come across?
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limited number of providers attitude/behavior of providers cultural insensitivity communication/ language differences case finding methods clinic environment appointment schedule
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What are some client barriers that the home health nurse might come across?
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personal / cultural views knowledge deficit stressful/ life experiences transport and child care influence of family previous experience care fear
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What are factors related to wellness?
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-Physical- exercise, destructive behavior, nutrition, rest, safety, seat belts -Emotional: feelings, humor, positive outlook -Spiritual: values, harmony with yourself, purpose in life -Social: relationships/interactions -Mental: time/stress management **very important
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What are the qualities of a nurse?
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-compassionate -caring -positive attitude -build on strengths -hassles/uplifts -stress reduction -positive role models -experience that shows a way of overcoming obstacles
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What is Healthy people 2020
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it's focus for the year 2020 is to create a society where all citizens live long lives through an interactive website They are NATIONAL GOALS for the entire country Increased life span for healthy people Reduced health disparities Maximize preventative services
